直视下左心房后壁射频消融微创迷宫术治疗风湿性心脏病心房颤动的临床对照研究

目的 通过对照观察探讨心脏瓣膜置换手术(换瓣术)过程中直视下微创迷宫术法射频消融左心房后壁治疗风湿性心脏病(风心病)慢性心房颤动(房颤)的可行性及疗效.方法 128例行心脏瓣膜置换术的风心病伴慢性房颤患者中,76例在换瓣术中直视下以微创迷宫术法射频消融左心房后壁,设计两条迷宫线路:一条为围绕4个肺静脉口外侧的环形线,另一条为连接左下肺静脉口下缘与二尖瓣后叶根部的最短直线.术中分次节段性消融,输出功率30～40W,放电时间45～60 S;术前3 d静脉应用胺碘酮,术后口服3个月停药;随访24个月.其余52例拒绝行射频消融微创迷宫术的风心病患者设为对照组,其换瓣术、胺碘酮应用及术后随访同射频消融微创迷宫术组(消融组).结果 随访24个月,消融组成功率81.58%(62/76),对照组成功率44.23%(23/52),P＜0.001,差异有统计学意义.结论 换瓣术中采用直视下在左心房后壁行射频消融微创迷宫术法能显著提高术后维持窦性心律的成功率,比传统的药物治疗疗效好,且方法简单,并发症少.胺碘酮有助于逆转心房电重构,减少房颤复发.

Radiofrequency mini-Maze procedure in left posterior atrial wall for patients with chronic atrial fibrillation undergoing valvular heart surgery

Objective The purpose of this study is to evaluate whether the radiofrequeney mini-Maze procedure in left posterior atrial wall undergoing valvular heart surgery was safe and effective for the patients with chronic atrial fibrillation(AF)and rheumatic heart disease(RHD).Methods One hundred and twenty-eight patients with AF and RHD were divided into 2 groups:radiofrequeney mini-Maze group and control group.Seventy-six patients in the mini-Maze group underwent the mini-Maze procedure by radiofrequeney abla-tion in the posterior region of the left atrium during the heart valve surgery.Two hnes of ablation were defined: one circle the four orifices of pulmonary vein and the other links the left lower pulmonary vein ostium to the pos-terior mitral annulus.The radiofrequency output Was 30～40W and the duration of discharge was 45～60 S at a time.Oral amiedarone was given from 3 days before the surgery until 3 months after the surgery.Fifty-two pa-tients in the control group were given amiodarone only.The follow-up duration was 24 months.Results In the mini-Maze group,62 patients could remain sinus rhythm 24 months later,the total successful rate was 81.58% (62/76).In the control group,only 23 patients remained in sinus rhythm,the successful rate was 44.23%(23/ 52).Conclusions The radiofrequency mini-Maze procedure in left posterior atrial wall undergoing valvular heart surgery is safe,effective and more simple for AF with rheumatic valvular disease.Amiodarone was admin-istered to help the maintenance of sinus rhythm and reduce the recurrence of AF.